Homestead_Folsom (4) ,h :,'-4 CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
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f„1; STANDARD I SUPPLEMENTAL DEDUCTION FORM
t\---._4 State Form 5473(R19/1-23) HC10 r)i<Y2
i le Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers are confidential under IC 6-1.1-12-37.
tt CERTIFICATION STATEMENT
I(We) rI{ 7 54`t"^ , certify that I(we)occupied as my(our)principal place of
residence or am(are)buying the follow g described real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
dal- is application' signed, (date of signature).I(We):
74 Own. ❑Am(are)buying under recorded contract.
• • (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
❑Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust.
❑Am(are)the shareholder,partner,or member of the entity that owns the property.
If Buying on Contract,Fee Simple Owner's Name
Recorder's Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
County J 0 Township rv�U ` Tatting District city,low,t
t`r
•
Parcel Numb r , Legal Description I t property in question:
Real Property ❑Annualy Assessed Mobile Horne(IC6-1.1.7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately sun nd that structure is used to produce income,describe the use and portion
of the property utilized
'tt000 produce Income.
_6
..._. 0 ....._ 20_ „..)...„
0— UOL1 ' Q-5-g -Oki .
• PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township is Claimant Vacating omestead?
❑Yes No
Si'turr of Claimant
I hereby certify the above statements are true,correct,and complete, t
Address of Contact(number and street,city,state,and ZIP code) 0 ,dr sot V.-ye. (ead,if y(nu,--rand street•city, e,andd ZIP
ASSESSOR USE ONLY I ASSESSED VALUE I HOMESTEAD VALUE NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately (1)
Surrounding Residential Improvement
Other Land (2) _ I
Total Land(line 1 plus line 2) (3) e
Residential Improvements or Dwelling (4)
Annually Ass ssed Mobile!
Manufactured Home Garage (5) AQ -
Other Improvements (6) 4R l
Total improvements(Line 4 through Line 6) (7) �' 4Vs
Total Value(Line 3 plus Line 7) (5) Q?j8S
Signature of Assessor ��y G C'cte Sign,(date,month.year)
I hereby certify the above is true,correct,and complete. Q(JAf
Verifying Action—Signature of Auditor - aAiir{JP'�ty.maAth,year)
STANDARD DEDUCTION ALLOWANCE
20 Pay 20 Lesser of 60%of the assessed value of the homestead or$48,000.
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home that $
is not assessed as real property or to a manufactured home that is not assessed as real property may not
exceed one-half(112)of the assessed value of the mo e hho` or manufactured home.
Signatur4`a td-or .—_
� 1 Date Signed n 11c;y,y r5+a y .,.^"'
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DISTRIBUTION:Original—County Auditor,FiteStamped Copy r
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